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Evaluation of Bactec™ Mycosis IC/F and Plus Aerobic/F blood culture bottles for the detection of Candida in the presence of antifungal agents.

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Evaluation of Bactec™ Mycosis IC/F and Plus Aerobic/F blood culture bottles for the detection of Candida in the presence of antifungal agents.

J Clin Microbiol. 2013 Aug 28;

Authors: Köck R, Eißing LC, Boschin MG, Ellger B, Horn D, Idelevich EA, Becker K

Abstract
Clinical practice guidelines recommend performing follow-up cultures for patients with candidemia in order to determine the time when Candida is cleared from the bloodstream. Since this requires collecting blood cultures from patients undergoing antifungal treatment, we evaluated two blood culture bottles (Bactec™ Mycosis IC/F (MICF), specifically adapted to the growth of fungi, and Bactec™ Plus Aerobic/F (PAF) containing resins to inactivate anti-infective agents) as to their effectiveness to detect C. albicans and C. glabrata when seeded in concentrations of 1 cfu/ml and 10 cfu/ml, respectively, together with human whole blood and different antifungal agents in therapeutic peak serum concentrations (Cmax). Significant differences between MICF and PAF vials for the detection of Candida spp. were found when inoculated with caspofungin (0/12 vs. 8/12; p<0.001) and amphotericin B (3/12 vs. 12/12; p<0.001). Inoculation of both fluconazole and voriconazole did not influence the effectiveness of detection in both MICF and PAF bottles (p=1.0). Neither MICF nor PAF bottles detected Candida spp. reliably when seeded together with anidulafungin (1/12 vs. 1/12; p=1.0) or micafungin (0/12 vs. 1/12; p=1.0). The time-to-positivity of both bottles when antifungal agents were added was significantly prolonged compared to controls without antimycotic drugs (p<0.001). Overall, the results of this in vitro study indicate that PAF bottles detected Candida spp. more reliably compared with MICF bottles when supplemented with certain antifungal agents. In consequence, clinical studies should now evaluate whether this holds true when taking blood cultures from patients undergoing antifungal treatment.

PMID: 23985911 [PubMed – as supplied by publisher]

Iatrogenic Cushing’s syndrome induced by posaconazole.

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Iatrogenic Cushing’s syndrome induced by posaconazole.
Antimicrob Agents Chemother. 2013 Aug 26;
Authors: Pilmis B, Coignard-Biehler H, Jullien V, Hermine O, Touraine P, Lecuit M, Lortholary O
Abstrac…

Fluconazole versus an echinocandin for Candida glabrata fungaemia: a retrospective cohort study.

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Fluconazole versus an echinocandin for Candida glabrata fungaemia: a retrospective cohort study.

J Antimicrob Chemother. 2013 Apr;68(4):922-6

Authors: Eschenauer GA, Carver PL, Lin SW, Klinker KP, Chen YC, Potoski BA, Shields RK, Clancy CJ, Nguyen MH, Lam SW

Abstract
OBJECTIVES: We studied whether fluconazole or echinocandin treatment of Candida glabrata fungaemia results in superior outcomes.
METHODS: A multicentre, retrospective study was performed with 224 adult patients who received ≥ 5 days of therapy with either fluconazole or an echinocandin as their first antifungal treatment after collection of a blood culture that grew C. glabrata. The primary outcome was day 14 complete response.
RESULTS: Patients in the echinocandin group were generally more ill, both at baseline and at the time of the index culture. Day 14 complete response was obtained in 58/127 (46%) and 50/97 (52%) of the fluconazole and echinocandin patients, respectively (P=0.383). Logistic regression found intensive care unit admission to be associated with failure [OR 0.456 (0.217-0.957), P=0.038] and echinocandin therapy to be associated with day 14 complete response [OR 2.305 (1.124-4.727), P=0.023]. Twenty-eight day survival was similar between the fluconazole and echinocandin groups and logistic regression did not reveal antifungal therapy choice to be independently predictive of mortality. For patients treated with fluconazole, a dose:MIC ratio >12.5 (when compared with a ratio ≤ 12.5) was associated with a significantly higher day 14 complete response [4/20 (20%) ≤ 12.5 versus 50/102 (49%) >12.5, P=0.025].
CONCLUSIONS: Severity of illness and choice of antifungal predict response in patients with C. glabrata fungaemia. Antifungal choice, however, does not influence mortality. In addition, new CLSI C. glabrata fluconazole susceptibility breakpoints are predictive of response when fluconazole is dosed appropriately.

PMID: 23212115 [PubMed – indexed for MEDLINE]

Successful management of fungal pericarditis and endocarditis in a neonate: A case report.

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Successful management of fungal pericarditis and endocarditis in a neonate: A case report.

J Saudi Heart Assoc. 2012 Jul;24(3):195-9

Authors: Azhar A

Abstract
Neonatal fungal endocarditis is a rare but serious infection, which does not have a well-accepted management method. This is the second report of this condition in Saudi Arabia. A preterm, very low birth weight, female neonate presented with fever and shortness of breath. An echocardiogram showed moderate pericardial effusion and two masses in the heart, one in the right ventricle and the other in the inferior portion of the posterior mitral valve of the left ventricle. Blood and pericardial fluid cultures revealed an infection with Candida albicans. The patient received a 60 days course of intravenous fluconazole and amphotericin B lipid complex. At the conclusion of treatment, she was discharged in good condition with no echocardiographic evidence of pericardial effusion or fungal vegetations. Thus, a successful outcome to a serious case of fungal endocarditis was achieved through aggressive antifungal therapy with intravenous fluconazole and amphotericin B lipid complex.

PMID: 23960695 [PubMed]